Meningite ya bagiteri, Menicococcal Septicemia, hamwe no gupima ikirahure¶

** Meningite ya bacteri ** (kwandura ubuzima bwa bagiteri kwanduza amazi akingira hamwe na membrane ikikije ubwonko nu mugongo) hamwe na ** meningococcal septicemia ** (uburozi bwuzuye bwuzuye bwa bagiteri buterwa na * Neisseria meningitidis *) biri mubintu byihutirwa byubuvuzi byica abantu. Umwana, umwangavu, umunyeshuri wa kaminuza, cyangwa umuntu mukuru arashobora kugaragara nkubuzima bwiza mugitondo cya mugitondo, akiteza imbere asa na grippe yoroheje cyangwa hangover kugeza saa sita, kandi agatera imbere muguhungabana kwa septique, herniation yubwonko, kunanirwa kwingingo nyinshi, necrosis, cyangwa gupfa mumasaha ** 12 kugeza 24.

Inshingano zawe zihuse mugihe bakekwa ko meningite ya bacteri cyangwa menicococcal septicemia ikekwa ni ukumenya ** hakiri kare "amaboko akonje n'ibirenge bikonje, ububabare bukabije bw'amaguru, hamwe n'uruhu rwera / ruvanze" septicemia prodrome ** amasaha mbere yuko ijosi rya kasike rikomeye cyangwa ibisebe bitagaragara, kora ikizamini cya ** gisobanutse neza cyibara ryuruhu rutukura cyangwa rudasanzwe, kubonana, kurinda umurwayi urumuri rwinshi no kuruka mugihe utegereje inkeragutabara, kandi ukamenyesha abakozi ba triage yibitaro wa kabiri uhageze kugirango antibiyotike yimitsi ishobora kwinjizwa muminota 30 kugeza 60.

Kora ubu¶

1. ** Hamagara serivisi zubuvuzi bwihutirwa niba hari amabendera atukura ya meningite cyangwa septicemia ahari: ** Hamagara nimero yawe yihutirwa (911 muri Amerika na Kanada, 112 hirya no hino mubumwe bw’ibihugu by’Uburayi, 999 mu Bwongereza, 000 muri Ositaraliya) cyangwa urebe ububiko bwacu bwa nimero yihutirwa niba umuntu ufite umuriro cyangwa uburwayi bwa vuba arwaye igisebe cya ** kidacogora munsi yikirahure gisobanutse **, ** ijosi rikomeye **, ** kubabara umutwe cyane hamwe no kumva ububabare bukabije bwurumuri rwinshi **, ** urujijo rushya cyangwa gusinzira bikabije **, ** gufatwa **, ** ahantu horoheje cyane (fontanelle) cyangwa gutaka kwinshi kwijujuta kurubuto rwamaguru ** hamwe nibirenge bikonje bikabije.
2. ** Kora "Ikirahure cya Tumbler" ku bibanza byose byuruhu ubungubu: ** Kanda uruhande rwikirahure gisukuye neza ushireho ibibara bitukura, umutuku, cyangwa ibara ry'umuyugubwe cyangwa ibikomere kuruhu. Niba ibibara ** bigumaho umutuku cyangwa ibara ry'umuyugubwe kandi urashobora kubibona neza ukoresheje ikirahure munsi yumuvuduko ukabije (non-blanching) **, fata ibi nkubuzima bwa ** meningococcal septicemia cyangwa sepsis byihutirwa ** hanyuma uhamagare ambulance ako kanya. Kuruhu rwijimye, reba ** imikindo yintoki, ibirenge, inda, imbere yijisho (conjunctivae), nigisenge cyumunwa (palate) **.
3. ** Ntuzigere utegereza guhubuka mbere yo guhamagarira ubufasha bwihutirwa: ** Abagera kuri kimwe cya kabiri cyabarwayi barwaye meningite ya bagiteri itanduye ntibigera barwara igisebe, kandi muri menicococcal septicemia, ibishishwa byijimye bitagaragara ni ikimenyetso cya ** cyatinze ** kigaragara nyuma yuko bagiteri zimaze gutangira gutemagura imiyoboro yamaraso. Niba umuntu asa nabi cyane kuruta ibicurane bisanzwe bya virusi, kora ako kanya.
4. ** Shyira umurwayi neza kandi ucane amatara yose yaka: ** Mugihe utegereje ambulance, uzimye amatara yo hejuru hanyuma ushushanye umwenda kugirango ugabanye gufotora bibabaza. Niba umuntu akangutse kandi akangutse nta guhungabana, reka baruhuke umutwe n'ibitugu byazamutseho gato kuri dogere 30 kugirango bagabanye umuvuduko wimitsi. Niba umuntu ** asinziriye, urujijo, cyangwa kuruka **, uzunguruke kuruhande rwabo mumwanya wa ** wo gukira ** kugirango kuruka ntibishobora kwinjira mubihaha.
5. ** Ntugire icyo utanga kumunwa (rwose NPO): ** Ntutange ibiryo, amazi, cyangwa ibinini byica ububabare. Abarwayi bafite meningite ikaze bakunze kuruka gitunguranye cyangwa guta ubwenge, kandi kumira amazi bitera kuniga bikabije no kwifuza.
6. ** Menyesha "Meningitis Bacterial Meningitis / Non-Blanching Rash" mugitangira guhamagarwa byihutirwa no kuri triage yibitaro: ** Koresha mu buryo bweruye amagambo * "ukekwaho indwara ya bagiteri meningite" * cyangwa * "umuriro ufite ibara ry'umuyugubwe utagira ibara" * mugihe avugana n’ubuvuzi bwihutirwa hamwe n’umuforomo w’ubutabazi kugira ngo umurwayi arengere icyumba cya antiyotike kugira ngo umurwayi atangire kwanduza antibiya.

flowchart TD
    Start["Umuriro, Malaise, Kubabara umutwe, cyangwa Indwara idasobanutse mubantu bakuru, ingimbi, umwana, cyangwa uruhinja"] --> CheckEarly{"1."}
    CheckEarly -->|Yes| CallEMS["Hamagara Serivise Yihutirwa (911/112/999) Ako kanya: Gukeka Menicococal Septicemia Yambere"]
    CheckEarly -->|No| CheckNeuro{"2. Reba ibimenyetso bya Meningite ya kera: Ijosi rikomeye, kubabara umutwe cyane, Photophobia, Urujijo, gufatwa, cyangwa kubyara Fontanelle?"}
    CheckNeuro -->|Yes| CallEMS
    CheckNeuro -->|No| CheckRash{"3."}
    CheckRash -->|Spots Do NOT Fade Under Glass| CallEMS
    CheckRash -->|Spots Fade or No Rash Yet| Reassess["4. Ongera usuzume buri minota 30 kugeza kuri 60: Ntuzigere usiga umurwayi wenyine ijoro ryose (Shiraho impuruza buri masaha 2)"]
    CallEMS --> Position{"5. Suzuma Umutimanama no Kuruka Mugihe Utegereje Ambulance"}
    Position -->|Drowsy, Unresponsive, or Vomiting| Recovery["Kuzenguruka Kuruhande Mumwanya wo Kugarura, Umuyaga mwiza, Icyumba cyijimye, Ntukagire icyo utanga kumunwa"]
    Position -->|Awake and Alert| Elevate["Kuruhuka utuje mucyumba cyijimye hamwe n'umutwe uzamuye Impamyabumenyi 30, Kurekura Imyenda Yoroheje, Gukurikirana Guhumeka"]

Sobanukirwa n'abicanyi bombi b'impanga: Meningite ya bagiteri na septiki ya meningococal¶

Nubwo abaturage bakunze kuvuga ko ibintu byombi ari "meningite", amabwiriza y’ubuvuzi yatanzwe n’umuryango w’ubuzima ku isi (OMS), Ikigo cy’igihugu cy’Ubwongereza gishinzwe ubuzima n’ubuvuzi (NICE NG240), hamwe n’ikigo cy’ubushakashatsi cya Meningitis bashimangira ko bagiteri nka *** Neisseria meningitidis * (meningococcus) ** na *** Streptococcus pneumoniae * (pneumocia **) ibihe byihutirwa **. Kumenya itandukaniro birasobanura impamvu abarwayi bamwe bafite uburibwe bwumutwe hamwe nijosi rinini hamwe na zeru zeru, mugihe abandi bafite umuvuduko ukabije wijimye wijimye hamwe nimbeho ikonje idafite ijosi rikomeye na gato.

Isaha-ku isaha ingengabihe: Impamvu amasaha 4 kugeza 8 yambere ari idirishya rikomeye¶

Mu bushakashatsi bwibanze bw’ubuvuzi bwashyizwe ahagaragara n’abashakashatsi ba Oxford (Thompson et al., * The Lancet *) busuzuma abana n’ingimbi barwaye indwara ya meningococcal, abaganga bavumbuye uburyo bubabaje: abarwayi benshi babonetse kandi boherezwa mu rugo n’umuganga cyangwa umubyeyi mu masaha ya mbere ya saa yine kugeza kuri 8 ** kubera ko bataragira ijosi rikomeye, fotofobiya, cyangwa igikara cyijimye. Ahubwo, muri ayo masaha 4 kugeza 8 yambere, berekanye ** ibimenyetso byihariye byo kuburira septisemiya hakiri kare ** bisa nkaho bitandukaniye gato nubukonje busanzwe bwa virusi cyangwa ibicurane:

Icyiciro cya 1: Indwara idasanzwe ya virusi isa (Amasaha 0 kugeza 4)¶

• Gutangira umuriro utunguranye (cyangwa kumva ushushe cyane no guhinda umushyitsi hamwe na rigor).
• Isesemi, kubura ubushake bwo kurya, kuruka, cyangwa impiswi (icyitonderwa: ** Serogroup W * Neisseria meningitidis *** izwiho gutangirana nububabare bukabije bwo munda, isesemi, nimpiswi yigana uburozi bwibiryo cyangwa gastroenteritis ikaze mbere yo gutera imbere byihuse kuri septique yica).
• Kubabara umutwe muri rusange, kubabara mu muhogo, no kurakara.

Icyiciro cya 2: Meningococcal septicemia triad (Amasaha 4 kugeza 8)¶

Kera cyane mbere yuko ibimenyetso bya meningite bya kera bigaragara (bikunze kugaragara nko mu masaha 12 kugeza 15)

1. ** Ububabare bukabije bw'amaguru, budasobanutse (myalgia) no kwanga kugenda: ** Kurenga ** 70 ku ijana by'abana n'abangavu ** bafite septique ya meningococal kare bafite uburibwe bukabije, kubabara, kubabara inyana zabo, ibibero, cyangwa umugongo wo hepfo biterwa no gukomeretsa kwa mikorosikopi ya mikorosikopi no mu mitsi minini ya capillary hypoperfusion. Mubana bato nabana bato, ibi bigaragarira nka ** kwanga gutungurwa guhagarara, kubyara ibiro, cyangwa kugenda **.
2. ** Amaboko n'ibirenge bikonje bikonje hamwe nigihe kinini cyo kuzuza capillary: ** Nubwo mugihe uruhanga rwumuntu cyangwa umubiri we wumva ushushe hamwe na dogere selisiyusi 39.5 (dogere 103.1 Fahrenheit), amaboko yabo nibirenge bumva ** bikonje bikabije gukoraho , hamwe nubushyuhe bukabije hagati yikiganza cyangwa inyana. Iyo ukanze cyane ku buriri bwabo, urutoki, cyangwa sternum kumasegonda 5 hanyuma ukarekura, uruhu rwera rutwara ** amasegonda arenga 2 kugeza kuri 3 ** kugirango uhindure ibara ryijimye ( gutinda kwuzuza capillary **).
3. ** Ibara ryuruhu rudasanzwe (pallor, mottling, or dusky iminwa yubururu): ** Kuberako umubiri urimo kwizirika kumitsi yamaraso ya peripheri kugirango ukize amaraso kumutima no mubwonko, uruhu rusa nigishashara cyera, imvi, ashene, cyangwa gikura lacy, net-imeze nkumutuku-wera (** mottling / livedo reticularis **) kumavi, ikibero, ikibero.

Icyiciro cya 3: Gutera Meningeal no guturika kwa hemorhagie (Amasaha 8 kugeza 15)¶

• ** Gukomera kw'ijosi (nuchal rigidity) **, ** Photophobia **, ** kubabara umutwe bikabije **, na ** bulging fontanelle ** (mubana) biragaragara.
• ** Ibibyimba bya petechial na purpuric biraturika: ** Ubwa mbere, utuntu duto twa milimetero 1 kugeza kuri 2 z'umutuku cyangwa umutuku wijimye (** petechiae ) cyangwa se uburiganya bwo guhisha virusi itukura isa na virusi igaragara ku gihimba, amaguru, cyangwa ururenda. Mu minota 30 kugeza kuri 90, utwo tuntu duto turagwira kandi tugahuriza hamwe mu binini binini, byijimye byijimye byijimye byijimye kandi bikomeretsa ( purpura na ecchymose **) ko ** bidashira munsi yikirahure gisobanutse **.

Icyiciro cya 4: Gutinda kwishyurwa no gutabwa muri yombi (Amasaha 15 kugeza 24)¶

• Urujijo, delirium, ubukangurambaga bwo kurwanya (kuva hypoxia cerebral no kubyimba ubwonko), guhagarika umutima, koma, gufatwa cyane, abanyeshuri bagutse, guhumeka neza bidasanzwe, no gusenyuka kwizunguruka (** purpura fulminans **).

Intambwe ku yindi: Nigute wakora Ikizamini cya Clear Glass Tumbler kuri tone zose zuruhu¶

A ** petechial cyangwa purpuric rash ** ntabwo ari uruhu rusanzwe; ni ** amaraso ya microscopique nyayo munsi yuruhu ** iterwa na endotoxine ya bagiteri na micro-clots (ikwirakwizwa na coagulation yo mu nda) isenya inkuta za capillaries ntoya. Kuberako amaraso yamenetse * hanze * imiyoboro yamaraso mubice byuruhu bikikije, gukanda hasi kuruhu ntibishobora gusubiza amaraso mumitsi. Niyo mpamvu guhubuka kwa meningococcal ** idahwitse (gushira) ** mukibazo.

Intambwe ya 1: Kora ikizamini cyikirahure ahantu hose hagaragara¶

1. Fata ikirahure gisukuye, cyoroshye, ** gisobanutse cyo kunywa ** (cyangwa igikombe gikomeye cya plastiki gisobanutse cyangwa lens ya magnificateur isukuye).
2. Kanda uruhande rwikirahure ** ushikamye kandi ushikamye ** muburyo butaziguye kuruhu cyangwa guhubuka kugirango uruhu ruzengurutse ruhinduke ibara ryumuvuduko.
3. Reba neza mu kirahure ahantu hamwe ukomeza umuvuduko uhamye:
4. ** Guhubuka guhumeka (Fades munsi yigitutu): ** Niba ibibara bitukura cyangwa byijimye byacitse burundu bigahinduka umweru / byera mugihe ukandagiye munsi yikirahure, hanyuma ugahinduka umutuku gusa nyuma yo kuzamura ikirahure, ibisebe ni ** kurubu **. * Icyitonderwa: * Indwara ya meningococal kare irashobora gutangira nka maculopapular rash kumasaha make yambere mbere yo guhinduka kutavanga; burigihe ongera ugerageze ahantu hashya buri minota 30 niba umuntu akomeje kumererwa nabi.
5. ** Kudahubuka (Ntabwo bigenda bishira mubitutu): ** Niba umutuku, umutuku wijimye, umutuku, cyangwa umukara-umukara pinpricks cyangwa blotches ** ukomeje kugaragara neza ukoresheje ikirahure nubwo igitutu gikomeye **, guhubuka ni ** kudahuzagurika (petechiae cyangwa purpura) **. ** Hamagara 911/112/999 ako kanya. **

Intambwe ya 2: Nigute ushobora kugenzura ibisebe bitavanze kuruhu rwijimye, umukara, n'umukara¶

Ku miterere yuruhu rwijimye (Ubwoko bwuruhu rwa Fitzpatrick IV, V, na VI), petechiae ntoya itukura cyangwa yijimye kumaboko, igituza, cyangwa umugongo birashobora kugorana cyane kubona kuruhu rwinshi cyane, bigatuma habaho gutinda kwisuzumisha. Mugihe usuzumye umuntu ufite uruhu rwijimye cyangwa Umukara, burigihe ukoreshe urumuri rwera rwera (nk'itara rya terefone, ntirigomba gucana urumuri rwicyumba cyumuhondo) hanyuma ugenzure byumwihariko uturere ** dutandatu tworoheje-twinshi twa anatomique **:

1. ** Imikindo y'amaboko yombi n'ibirenge byombi: ** Kanda ikirahure gisobanutse neza hejuru yikintu gito cyijimye cyijimye, umutuku, cyangwa umukara ku biganza no ku birenge.
2. ** Imbere y'ijisho ryo hepfo (palpebral conjunctivae): ** Kuramo witonze witonze ijisho ryo hepfo hanyuma urebe utuntu duto duto duto duto cyangwa umutuku wijimye wijimye ku murongo w'imbere wijimye.
3. ** Abazungu b'amaso (sclerae): ** Reba neza ibibara bitukura bitukura cyangwa amaraso mato mato mato.
4. ** Igisenge cyumunwa (umunwa ukomeye kandi woroshye) no mumatama (buccal mucosa): ** Saba umuntu gukingura umunwa mugari kandi amurikire itara kumunwa no kumunwa w'imbere kugirango abone petechiae itukura cyangwa yijimye.
5. ** Inda, ikibero cyimbere, hamwe nigituba gikonjesha: ** Uruhu akenshi ruba rworoshye kandi rworoheje gato ahantu horoheje kandi hapfukiranwa, aho umuvuduko ukabije wumukondo wikibuno akenshi utera petechiae mbere.
6. ** Tactile palpation ya purpura yateye imbere: ** Bitandukanye na virusi ya virusi iringaniye, guhuriza hamwe meningococcal purpura akenshi yumva gake ** yazamutse cyangwa igahita ** munsi yintoki zawe nkibidendezi byamaraso imbere murwego rwuruhu rwa nerotic.

Ibimenyetso bifatika byo kurakara meningeal: Gukomera kw'ijosi, ikimenyetso cya Kernig, ikimenyetso cya Brudzinski, n'ikizamini cya Jolt Accentuation¶

Iyo bagiteri na selile yamaraso yaka meninges itwikiriye ubwonko nu mugongo, ikintu icyo aricyo cyose cyumubiri kirambura imizi yumugongo cyangwa ururenda rwa dural itera imitsi ikingira imitsi nububabare. Mugihe abafasha bambere badakeneye gukora ibizamini bigoye byubwonko, gusobanukirwa uburyo kunangira ijosi no kubabara umutwe bitwara muri meningite bifasha kubitandukanya n imitsi yoroshye yakuwe mu ijosi cyangwa kubabara umutwe:

1. Ukuri kwijosi ryukuri rya meningeal (Nuchal rigidity) nu ijosi rirwaye¶

• Muburyo busanzwe bwimitsi cyangwa inkondo y'umura, guhindura umutwe uruhande rumwe ("kuzunguza umutwe Oya") birababaza kimwe no kunama umusaya hasi.
• Muri ** acute meningitis **, kuzunguruka umutwe witonze uruhande rumwe kuruhande birashobora kuba bishoboka, ariko ** guhinduranya ijosi imbere ("kwunama Yego" kugirango uzane urushyi werekeza mu gituza) ** urambura urutirigongo rwaka ururenda rurerure, rutera kubushake butameze nkimitsi yo mu ijosi imitsi yaguka kandi ububabare bukabije butanga umugongo.
• ** Nigute ushobora kugenzura witonze utabanje guhatira ijosi: ** Baza umuntu (niba akangutse kandi udakomeretse kugwa) ngo ** gerageza gukora ku matama yabo mu gituza cyambaye ubusa mugihe umunwa ufunze **. Niba badashobora kuzana umunwa wabo mubice bibiri kugeza kuri bitatu by'ubugari bw'igituza batagira ijosi rikomeye n'ububabare, fata nk'uburyo bukomeye bwa nuchal. ** Ntuzigere usunika umutwe wumurwayi imbere. **

2. Ikizamini cya "Jolt Accentuation yo Kubabara Umutwe"¶

Mu rubyiruka ndetse nabakuze bafite umutwe numuriro byatangiye, abaganga byihutirwa bakoresha ikizamini cya ** Jolt Accentuation **: saba umurwayi guhindura umutwe utambitse ibumoso niburyo ku buryo bwihuse bwa ** 2 kugeza kuri 3 kumasegonda ** (nkaho bazunguza umutwe "Oya"). Niba kuzunguza umutwe utambitse bituma umutwe wabo utera cyane, byerekana uburibwe bwa meningeal.

3. Ibimenyetso bya kuryama bya kera (ibimenyetso bya Brudzinski na Kernig)¶

Nubwo uzwi cyane mubitabo, ikimenyetso cya ** Brudzinski ** na ** Ikimenyetso cya Kernig ** gifite sensibilité nkeya (5 kugeza 30%), bivuze ko kubura kwabo kutigera bibuza meningite, nubwo kuba bahari byemeza uburakari bwa meningeal:

• ** Ikimenyetso cya ijosi rya Brudzinski: ** Iyo umurwayi aryamye ku mugongo kandi akazamura umutwe yerekeza mu gituza, byombi ** ikibuno n'amavi bihita bihindagurika hejuru ** bidatinze kugira ngo bigabanye impagarara ku ruti rw'umugongo rwaka.
• ** Ikimenyetso cya Kernig: ** Iyo umurwayi aryamye neza hamwe n'ikibero kimwe n'amavi byunamye ku mpande ya dogere 90, kugorora ukuguru kw'iburyo hejuru bitera spasme ikabije no kubabara umugongo cyangwa ijosi.

Kumenya meningite kubana bavutse, impinja, nabana bato (Ninde udashobora kuvuga umutwe cyangwa ijosi rikomeye)¶

Abana bavutse (bari munsi yiminsi 28) nimpinja (munsi yumwaka 1) batwara ** indwara ya meningite ya bagiteri yo mumyaka iyo ari yo yose ** (itwarwa nitsinda B * Streptococcus *, * Escherichia coli *, * Listeria monocytogenes *, * Streptococcus pneumoniae *, na * Neisseria meningitidis *), nyamara * Neisseria meningitidis *), nyamara * Neisseria meningitidis *). Ahubwo, abarezi b'abana bategerezwa kuraba ayo mabendera atukura yihariye:

Amatsinda afite ibyago byinshi bikunze gusuzumwa nabi: Abanyeshuri ba kaminuza, abantu bakuru, n'abarwayi badafite intanga¶

1. Abanyeshuri ba mbere muri kaminuza, amashuri yindaro, hamwe n’ikigo cya gisirikare ("Fluhers 'Flu" na Meningitis)¶

Ingimbi n'abangavu bafite imyaka iri hagati ya ** 16 na 24 ** baba mu macumbi asanganywe, mu mazu atuyemo, cyangwa mu kigo cya gisirikare bafite umubare wa kabiri mu ndwara ya meningococcale kuko abagera kuri ** 20 kugeza kuri 25 ku ijana by'ingimbi bitwaza * Neisseria meningitidis * nta nkomyi inyuma y'izuru n'umuhogo (gusohora imitsi ya nasofaryngeal).

• ** Umutego wa "Hangover" na "Freshers 'Flu": ** Buri gihe cyizuba, abanyeshuri ba kaminuza bapfira muburiri bwa dortoir kuko abo babana bakeka ko umunyeshuri ufite uburibwe bwumutwe, kuruka, gufotora, no gusinzira ni ** gusinzira inzoga ** (ubusinzi) cyangwa ifite ikigo gisanzwe gikonje.
• ** Amategeko yo Kurinda Amacumbi: ** Ntuzigere usiga uwo mubana urwaye cyangwa uruka wenyine inyuma yumuryango wicyumba ufunze kugirango "uryame." Ubasuzume imbonankubone buri masaha 1 kugeza kuri 2, fungura urumuri muri make kugirango urebe uruhu rwabo rudakabije kandi urebe niba bashobora kuvuga neza kandi bakunama ijosi, hanyuma uhamagare ubutabazi bwihuse niba bayobewe, bafite amaboko / ibirenge bikonje, cyangwa badashobora kwihagararaho.

2. Abakuze bakuze (barengeje imyaka 60) nabarwayi badafite intanga¶

Ku bantu bakuze barengeje imyaka 60 hamwe nabantu bari kuvura immunosuppressive, ** kunangira ijosi hamwe numuriro mwinshi usanga byoroheje cyangwa bidahari **. Ahubwo, meningite ya bagiteri (cyane cyane ituruka kuri * Streptococcus pneumoniae * cyangwa * Listeria monocytogène *, bagiteri yo mu biribwa irwanya antibiyotike ya cephalosporin kandi ikenera ampisilline yo mu maraso) ubusanzwe igaragaza nka ** delirium itunguranye, urujijo, ubunebwe, cyangwa ingorane zo kuvuga ** yigana cyane a. inkorora.

Umuntu wese wagize ** kubaga splenectomy ** cyangwa afite ** imikorere ya asplenia ** (harimo nabantu bose bafite indwara y'umuhoro) ibura akayunguruzo kambere ko kurimbura ** bagiteri ya bagiteri ** (* Streptococcus pneumoniae *, * Neisseria meningitidis *, na grippe Haemophilus *). Aba bantu barashobora kwandura ** Kwanduza Indwara Yanduye (OPSI) **, bikava mumuriro woroheje bikagera kuri septique yica muri ** bitarenze amasaha 6 kugeza 12 **, kandi bagomba guhita bajya mubiro byihutirwa kukimenyetso cya mbere cyumuriro cyangwa gukonja.

Imfashanyo yambere yibitaro nicyo ugomba gutegereza murwego rushinzwe ubutabazi¶

Intambwe ku yindi ubuvuzi mbere y'ibitaro mugihe utegereje ambulance¶

1. ** Komeza inzira yumuyaga nu mwanya ukurikije imyumvire: **
2. ** Niba ukangutse, ube maso, n'umuvuduko w'amaraso uhagaze neza: ** Komeza umuntu aruhuke atuje mucyumba cyijimye, gituje n'umutwe hamwe n'umubiri wo hejuru uzamurwa kuri dogere 30 30 **. Kuzamura umutwe bitera imbaraga nkeya gutembera mu maraso biva mu bwonko binyuze mu mitsi, bifasha kugabanuka kuzamuka k'umuvuduko w'amaraso (ICP). Bika ijosi ryabo muri ** igororotse rwagati ** (ntugahindure umutwe cyane kuruhande, ruhuza imitsi yimbere).
3. ** Niba ibitotsi, binangiye, kuruka cyane, cyangwa nyuma yo gufatwa: ** Uzunguruke kuruhande rwabo mumwanya wa ** wo gukira ** ako kanya kugirango kuruka n'amacandwe bitemba neza mumunwa.
4. ** Niba muri septique .
5. ** Kurinda mugihe cyo gufatwa: ** Abagera kuri 20 kugeza 30% byabarwayi ba meningite ya bagiteri bahura na tonic-clonic rusange gufatwa kubera kurakara cortical no kubyimba ubwonko. Shyira umutwe hamwe n'ikoti cyangwa umusego wiziritse, ibikoresho bisukuye kure, igihe cyo gufatira hamwe nisaha, ntuzigere ushyira ikintu na kimwe mumunwa, hanyuma ubizunguruze kuruhande rwabo iyo gutereta bihagarara.
6. ** Irinde iyicarubozo ryo gukonjesha umubiri (nta bwogero bukonje cyangwa urubura) Guhinda umushyitsi ikirere-roketi ubwonko bwa ogisijeni hamwe n'umuvuduko ukabije. Kuraho gusa imyenda iremereye cyangwa ibishishwa byiyongereye kugirango ubushyuhe bushobore guhunga bisanzwe, mugihe ubitse urupapuro rworoshye hejuru yabo niba rufite ubukonje.
7. ** Kusanya amateka akomeye kubatabazi nabaganga byihutirwa: ** Andika cyangwa witegure kubwira itsinda ryabaganga:
8. Igihe nyacyo umuntu yaherukaga neza rwose nigihe nyacyo guhubuka cyangwa urujijo byatangiye.
9. Niba barabonye antibiyotike zo mu kanwa mucyumweru gishize (zishobora guhisha igice cyimico ya cerebrospinal fluid fluid).
10. Amateka ayo ari yo yose yanduye mu matwi (itangazamakuru rya otitis) **, ** sinusite **, ** mastoiditis **, ** ihahamuka ry'umutwe / kuvunika umutwe wa gihanga ** (amazi meza atemba ava mu mazuru cyangwa ugutwi yerekana ubwonko bwa cerebrospinal fluid * butanga * Streptococcus pneumoniae * umuhanda utaziguye mu bwonko), ** splenectomy **, ** umuhoro wa **.

Kuki ibitaro bitanga antibiyotike yimitsi na dexamethasone mumasaha yambere¶

Mu ishami ryihutirwa, meningite ya bagiteri na septicemia ya meningococcal itera intego ya ** "Door-to-Antibiotic" intego yo munsi yiminota 60 ** (buri saha yo gutinda gutangira antibiyotike ya bagiteri itera imitsi byongera cyane impfu nubumuga buhoraho bwubwonko):

• ** Imico yamaraso hamwe na antibiyotike zihita zinjira: ** Mbere yo gukora igikoma cyumugongo (lumbar puncture) niba hakenewe mbere na mbere scan ya CT cyangwa niba umurwayi afite ikibazo cya septique, abaganga bashushanya imico yamaraso hanyuma bagahita binjiza antibiyotike yimitsi myinshi, mubisanzwe cephalosporin (** ceftriaxone cyangwa ** cefotaxime **) pneumoniae *) na ** ampicillin / amoxicillin ** (niba umurwayi atarengeje ukwezi 1, hejuru yimyaka 50, atwite, cyangwa adafite ubudahangarwa, kugirango apfuke * Listeria monocytogene *).
• ** Umuyoboro wa dexamethasone (corticosteroid) mbere cyangwa hamwe na antibiyotike ya mbere: ** Iyo antibiyotike yo mu mitsi yibasiye bagiteri mu mazi yo mu bwonko bwa cerebrospinal, bagiteri zipfa zimeneka hanyuma zikarekura umuyaga utunguranye w’ibice bigize urukuta rw’urukuta rushobora gutera umuvuduko ukabije mu kubyimba ubwonko ndetse no kwangirika kw'imitsi yo mu matwi (** sensorineural kumva). Gutanga ** imitsi ya dexamethasone ** iminota 10 kugeza kuri 20 mbere cyangwa icyarimwe hamwe nigipimo cya mbere cyambere cya antibiotique ihindura iyi ndwara yumuriro, bikagabanya cyane urupfu muri meningite ya pneumococal no kwirinda ubumuga bwo kutumva burundu.

Kurinda umubano wa hafi: Ninde ukeneye antibiyotike ya prophylaxis nyuma yo guhura?¶

Iyo hagaragaye indwara ya ** meningococcal (* Neisseria meningitidis *) ** cyangwa *** Haemophilus grippee * ubwoko bwa b (Hib) ** isuzumwe (icyitonderwa: * Streptococcus pneumoniae * meningitis ntabwo ** isaba antibiyotike ikingira abantu), ubuyobozi bwa leta bwanditse kuri chimoprophylaxx ** kurandura gutwara umuhogo no guhagarika imanza za kabiri.

Menyesha abashinzwe ubuzima rusange cyangwa umuganga kugirango antibiyotike ikingire mu masaha 24 yo kwisuzumisha ** niba uri ** hafi **, bisobanurwa na CDC, OMS, n’ikigo cy’ubuzima cy’Ubwongereza nka:

• ** Abagize urugo: ** Umuntu wese ubana kandi uryamye munzu imwe, icyumba cyo kuraramo, cyangwa gusangira igorofa nkumurwayi mugihe cyiminsi ** 7 mbere yuko ** ibimenyetso bitangira.
• ** Guhuza ibanga no mu kanwa: ** Umuntu wese wagiraga umubano utaziguye numurwayi wumunwa (nko gusomana byimazeyo, gusangira amenyo cyangwa ibinyobwa, cyangwa guhuza ishuri ryincuke) muminsi 7 mbere yuburwayi.
• ** Abashubije bwa mbere bafite uburyo bwo guhumeka butakingiwe: ** Gusa ababajijwe bakoze ** guterura umunwa kumunwa kumunwa, guhumeka inzira idakingiye, cyangwa intubation ** idafite mask yo mumaso mbere yamasaha 24 yo kuvura antibiotique. Ibyumba by'ishuri, biro, cyangwa ambulance itabonetse nta gutonyanga kumanwa itaziguye ntabwo ** isaba antibiotique ikumira.

Ibibazo bikunze kubazwa¶

Inkomoko yagenzuwe¶

• ** Ikigo cy’igihugu gishinzwe ubuzima n’ubuvuzi (NICE, Ubwongereza): ** * Indwara ya Meningite (Indwara ya bagiteri) n’indwara ya Meningococcal: Kumenya, gusuzuma no gucunga (NICE Guideline NG240, ivugururwa 2024) *.
• ** Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS): ** * Gutsinda Meningite muri 2030 Global Roadmap * na * Igitabo cyo mu mufuka cyo kwita ku bitaro byita ku bana: Gutwara no gucunga indwara ya Meningite na Meningococcal Septicemia *.
• ** Indwara zanduza Sosiyete yo muri Amerika (IDSA) hamwe n’ibigo bishinzwe kurwanya no gukumira indwara (CDC, Amerika): ** * Amabwiriza ngenderwaho yo gucunga indwara ya Meningite ya bagiteri * na * Igitabo cyo gukurikirana indwara zikingira inkingo: Indwara ya Meningococal *.
• ** Umuryango w’ibihugu by’i Burayi by’ubuvuzi bwa Microbiologiya n’indwara zandura (ESCMID): ** * Amabwiriza ya ESCMID yerekeye gusuzuma no kuvura indwara ya Meningite ikaze *.
• ** Thompson MJ, Ninis N, Perera R, n'abandi. .
• ** Fondasiyo y'Ubushakashatsi bwa Meningite (MRF) na Meningitis Ubu (Ubwongereza): ** * Ibendera ry'umutuku wa Clinical hamwe n'ikizamini cy'ikirahure kuri tone zose z'uruhu *.

Kuyobora¶

• Sepsis na septike ihungabana kumenyekana nubutabazi bwihutirwa
• Gufata no gutabara byihutirwa
• Shira imfashanyo yambere hamwe no kuzenguruka kugwa
• Indwara ya selile irwaye hamwe nibikorwa byihutirwa bya asplenia
• Imibare yihutirwa ukurikije igihugu